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Case Reports
. 2021 Nov 15;2(20):CASE21448.
doi: 10.3171/CASE21448.

Orthostatic hypotension after cervicomedullary junction surgery: illustrative case

Kasper S Jacobsen  1   2 , Rico F Schou  3 , Frantz R Poulsen  1   2 , Christian B Pedersen  1   2
Affiliations
Case Reports

Orthostatic hypotension after cervicomedullary junction surgery: illustrative case

Kasper S Jacobsen et al. J Neurosurg Case Lessons. .

Abstract

Background: Surgery at the cervicomedullary junction carries a risk of damaging vital brainstem functions. Because the nucleus of the solitary tract (NS) is involved in the baroreceptor reflex, damage to its integrity may lead to orthostatic hypotension.

Observations: A 56-year-old man with a medical history of hypertension, von Hippel-Lindau disease, and previous bilateral adrenalectomy due to pheochromocytoma was referred with symptoms of dysphagia and paralysis of the left vocal cord. Paralysis of the left vagus nerve was suspected. Magnetic resonance imaging revealed a contrast-enhancing cystic process in the cervicomedullary junction. Twenty-three years earlier, the patient had undergone surgical treatment for a hemangioblastoma in the same region. After repeated surgery, the patient temporarily developed orthostatic hypotension. At discharge, the patient no longer needed antihypertensive medication.

Lessons: Surgery near the cervicomedullary junction can affect the NS, leading to disruption of the baroreceptor response that regulates blood pressure.

Keywords: MRI = magnetic resonance imaging; NE = norepinephrine; NS = nucleus of the solitary tract; cervicomedullary junction; fossa posterior; hemangioblastoma; nucleus tractus solitarius; orthostatic hypotension; pheochromocytoma.

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Conflict of interest statement

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

Figures

FIG. 1.
FIG. 1.
Presurgical sagittal, gadolinium contrast-enhanced, T1-weighted MRI. The white arrow points to the primary cystic process with contrast-enhancing elements.
FIG. 2.
FIG. 2.
Presurgical axial, gadolinium contrast-enhanced, T1-weighted MRI. The white arrow points to the primary cystic process.
FIG. 3.
FIG. 3.
Sagittal, gadolinium contrast-enhanced, T1-weighted MRI 9 months after surgery. The white arrow points to the residual cystic component that has decreased since the operation.
See this image and copyright information in PMC

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